Candidiasis of the nervous system

Aarti U Jerath BA (Ms. Jerath of the University of Illinois College of Medicine has no relevant financial relationships to disclose.)Chandan Reddy MD (Dr. Reddy of the University of Iowa has no relevant financial relationships to disclose.)Karen L Roos MD FAAN, editor. (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)Originally released June 13, 2005; last updated September 27, 2009; expires September 27, 2012Notice: This article has expired and is therefore not available for CME credit.

Candida became a common central nervous system pathogen in the 1960s with the advent of chemotherapeutic agents, glucocorticoids, and intravenous drugs; candidiasis is now responsible for more than 90% of all clinically significant fungal infections. Meningitis is the most common form of CNS infection. The clinical symptoms are highly variable and range from acute to chronic. Careful examination of the ocular fundus and the skin provides clues to suspect candida infection. There is an increased incidence of both disseminated and CNS candidiasis in newborns, especially premature infants. In some specific clinical situations, such as bone marrow transplant recipients or severe burn patients, Candida is the leading cause of CNS infection. Diagnosis is often made from biopsy specimens or culture. Candida meningitis responds best to intravenous amphotericin B and oral 5-fluorocytosine. The initial treatment of Candida brain abscess, epidural abscess, and intramedullary abscess is with amphotericin B and 5-fluorocytosine.

Historical note and terminology

The history of candidiasis dates back to the 4th century BC when Hippocrates described oral aphtha (thrush) in 2 patients with severe underlying disease. In 1861, Zenker discovered an organism-like Candida in brain lesions. A brain abscess caused by Candida species was initially reported in 1895 (Kwon-Chung and Bennett 1992). In 1933 Smith and Sano identified the first case of Candida meningitis, but it was not until 1943 that Candida was successfully cultured from a cerebral lesion. Candida remained a relatively uncommon CNS pathogen until the 1960s when use of chemotherapeutic agents, glucocorticoids, and intravenous drugs rendered increasing numbers of patients susceptible to opportunistic infections (Scheld et al 2004).

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